Comfort - End-of-Life

What are the intended purposes of massage therapy for the dying patient? Select all that apply. 1 Decrease pain 2 Enhance dignity 3 Decrease nausea 4 Promote relaxation 5 Reduce the need for analgesics

1,2,4 Massage is a popular complementary therapy for patients at end of life. Massage decreases pain in patients with cancer. Daily massage helps the patient feel well and enhances dignity. Patients are relaxed and find peace when massage is incorporated into the palliative plan of care. Massage does not decrease nausea or reduce the need for analgesics. Pain medication is given to the patient round the clock for pain relief.

A dying patient becomes increasingly withdrawn and begins to refuse to eat and drink. What intervention does the nurse implement? 1 Offers ice chips 2 Gives intravenous hydration 3 Calls the family to come in right away 4 Brings in the patient's favorite Chinese takeout food

1 Offers one chips The dying patient should not be forced to eat or drink, but small sips of liquids or ice chips at frequent intervals can be offered if the patient is alert and able to swallow. This helps the patient with problems of dehydration and "dry mouth." The dying patient's metabolic needs have decreased, so the patient will not want any food or drink. Calling the family is not yet necessary in this patient's case. Because the dying patient's metabolic needs have decreased, invasive procedures are not necessary at this point.

A terminally ill patient is experiencing delirium. What drug does the nurse expect the physician to prescribe? 1 Atropine 2 Lorazepam 3 Haloperidol 4 Furosemide

3 Haloperidol Delirium may occur in a week or two before death. Haloperidol is the drug of choice in such cases. Anticholinergics, such as atropine, are commonly given to dry up secretions, not to relieve delirium. Benzodiazepines, such as lorazepam, are the drugs of choice for seizure management, but they do not treat delirium. Furosemide is a diuretic and is used to decrease blood volume, reduce vascular congestion, and reduce the workload of the heart, not to relieve delirium.

A dying patient says to the nurse, "I am afraid to die. I did a lot of wrong things in my life." How does the nurse respond? 1 "Tell me more about that." 2 "Why? What did you do wrong?" 3 "Don't worry, God will forgive you." 4 "I'm sure it is nothing to worry about."

1 "Tell me more about that." A response such as, "Tell me more about that," acknowledges the patient's spiritual pain and encourages verbalization. "Don't worry, God will forgive you" assumes that the patient is religious and minimizes the patient's concerns; it gives false reassurance and is a nontherapeutic response. Saying that it's nothing to worry about minimizes the patient's concerns and is a nontherapeutic response; it shuts the patient off from expressing his or her concerns. Asking why the patient is afraid and what he or she did wrong assumes that the patient did something wrong, which may not be the case. "Why" questions are never considered to be therapeutic because they place patients on defense; they often stop communication.

A hospitalized patient of the Islamic (Muslim) religion is dying. What concept does the nurse share with the health care team about this patient's beliefs about death? 1 Death is seen as the beginning of a new and better life. 2 Plans for burial will take days, maybe even weeks, after the death. 3 The timing of death is under the power of the person who is facing death. 4 Life experiences do not affect the individual's preparation for "everlasting life."

1 Death is seen as the beginning of a new and better life. In the Muslim faith, death is seen as the beginning of a new and better life. This is a fundamental belief of the religion. Life is meant to be a test of preparation for everlasting life in the hereafter; life experiences do affect the person's afterlife existence. Muslims believe that God, Allah, rather than the person, has prescribed a time of death for everyone. Preparation for burial takes place as soon as possible after death has occurred.

What psychosocial intervention should the nurse provide while caring for a dying patient? 1 Promote spirituality 2 Avoid cultural practices 3 Discourage reminiscence 4 Give explanations of the loss

1 Promote Spirituality While caring for a dying patient, the nurse should promote spirituality, which can help the patient cope. Also, the nurse should encourage reminiscence and respect cultural practices, not discourage or avoid them. Explanations of loss should be avoided.

The nurse is teaching the family members about providing care to a patient with a terminal illness whose sleep is increased. Which teaching by the nurse is appropriate? 1 "Eliminate having people in the room." 2 "Spend time sitting quietly with the patient." 3 "Play loud music while the patient is sleeping." 4 "Prompt the patient to talk to keep him or her awake."

2 "Spend time siting quietly with the patient." The older patient who has increased sleep at the end of life should be provided proper care. Family members should spend time with the patient sitting quietly. Family members can talk to the patient in a normal way, even if the patient does not respond. It is not required to reduce the number of people in the room; this would help if the patient was restless. Family members should not play loud music; however, soft music may be soothing to the patient. The patient should not be forced to talk to stay awake.

The trauma nurse is providing care to a patient who was involved in a motorcycle accident and requires emergency surgery for internal injuries. The patient states, "I was never baptized, and I don't want to go to purgatory." Which response by the nurse is most appropriate? 1 "Would you like me to call your family?" 2 "Would you like me to contact the hospital priest?" 3 "Let's pray together before you are taken to surgery." 4 "I will make sure a chaplain is available after surgery."

2 "Would you like me to contact the hospital priest?" People may be baptized as Roman Catholics in emergency situations. The most appropriate response by the nurse is to contact the hospital priest who can perform baptism for this patient prior to surgery. Although calling the family may also be appropriate, this does not address the patient's concern. Making sure a priest is available after surgery does not address the need to baptize the patient prior to the surgical procedure. Although the nurse may choose to pray with a patient if asked to do so, this does not address the concern for baptism.

When does the nurse recognize that death has occurred in a patient? 1 Eyes close 2 Breathing stops 3 Jaw closes tightly 4 Pupils become constricted

2 Breathing stops When breathing stops, the heart stops beating and it is evident that death has occurred in the patient. Other physical manifestations of death include fixed and dilated pupils. The eye may close or remain open without blinking. The jaw may fall open.

Which nursing statement helps the terminally ill patient express internal spiritual feeling? 1 "Everything will be fine." 2 "I am sorry this is happening." 3 "Everything happens for the best." 4 "Tell me about some things that are important to you."

4 "Tell me about some things that are important to you" In order to assess a patient's spirituality, the nurse can post open-ended questions or statements, such as "Tell me about some things that are important to you." This helps fulfill the spiritual needs of the patient, which can help with existential distress. The nurse should not give trite assurances like "Everything will be fine." By saying "I'm sorry this is happening," the nurse can express grief, but this doesn't open the door for a patient to express his or her own feelings. Statements such as "Everything happens for the best" are not helpful when the person has yet to express feelings of anguish or anger.

The nurse is caring for a patient with an end-stage terminal illness. What indications of pain and discomfort may the nurse observe when the patient sleeps for more than 20 hours a day? Select all that apply. 1 Moaning 2 Grimacing 3 Restlessness 4 Talking during sleep 5 Breathing pattern changes

1,2,3 The sleeping patient is likely in pain and discomfort if he or she grimaces when changing positions, moans, or is restless. Talking during sleep is not an indication that the patient is in pain. Breathing pattern changes are a common physical sign of approaching death.

What does spirituality address in the life of a patient? 1 It describes a formal belief system. 2 It keeps questioning the purpose of life. 3 It shows a firm adherence to religious rituals. 4 It facilitates reflecting on memories of events from his or her own life.

2 It keeps questioning the purpose of life A person's spirituality may or may not include belief in God; hence, a spiritual person might question the purpose of life because this is what any type of spirituality addresses. A religious person, not necessarily a spiritual person, has a formal belief system that is common to the whole community. Spirituality exists regardless of beliefs about religious practices. Reflecting on memories of events from own life is referred to as reminiscence; it helps to attain perspective and enhance meaning but does not relate to a person's spirituality.

Which alternate term should the nurse use when discussing spiritual distress? 1 Moral 2 Religious 3 Existential 4 Psychosocial

3 Existential Another term the nurse can use when discussing spiritual distress is existential distress. Moral, religious, and psychosocial are related but not synonymous with spiritual distress.

A patient died suspiciously and unexpectedly. What should the nurse do in this situation? 1 Remove tube and lines 2 Clean the patient's room 3 Notify the medical examiner 4 Document the death certificate

3 Notify the medical examiner If a patient dies suspiciously, the nurse notifies the medical examiner to identify the cause of death. Tubes and lines are removed if the death is expected and no autopsy is planned. A patients' room should be cleaned during postmortem care. A death certificate should be documented when the death is pronounced if the death is expected.

What belief is common among Roman Catholics? 1 People must be baptized by the priest. 2 A funeral should occur as soon as possible after someone dies. 3 The Sacrament of the Sick can be administered at any time during a person's illness. 4 A person who misses receiving the Sacrament of the Sick is denied entry into heaven after death.

The Sacrament of the Sick can be administered at any time during a person's illness. Roman Catholics believe that the Sacrament of the Sick can be administered at any time during a person's illness. Although Roman Catholics are often baptized by a priest, in an emergency situation, such as when a person is dying, a patient may be baptized by a layperson too. People following Judaism believe the funeral of the dead body should be done as soon as possible. Roman Catholics do not believe that missing the Sacrament of the Sick denies a person's entry into heaven after death.

The caregiver of a terminally ill patient reports that the patient sleeps through the day and avoids eating and drinking. The nurse finds that the patient has cold extremities. The nurse teaches care management to the patient's caregiver. Which caregiver's statement indicates effective learning? 1 "I should not force the patient to eat." 2 "I should encourage the patient to stay awake during the day." 3 "I should position the patient on his or her back while sleeping." 4 "I should cover the patient with an electric blanket to provide warmth."

1 "I should not force the patient to eat" Cool extremities, increased sleeping, and reduced hunger are the physical signs and symptoms of approaching death in a terminally ill patient. In such a situation, the patient should not be forced to drink or eat, nor stay awake. The patient should be positioned on his or her side to allow easy breathing and to cough up secretions. A terminally ill patient may have impaired skin integrity. Therefore, the nurse should not cover the patient with blankets or a heating pad.

Which patient statement regarding durable power of attorney for health care (DPOAHC) indicates a need for further teaching? 1 "It is the same as durable power of attorney (DPOA) for financial affairs." 2 "It is often referred to as health care proxy, health care agent, or surrogate decision maker." 3 "It allows the individual to make a decision only if the patient has become cognitively impaired." 4 "It requires the decision maker to receive information, evaluate, deliberate, and communicate a treatment preference."

1 "It is the same as durable power of attorney (DPOA) for financial affairs." An individual serving as the DPOAHC can be different from the individual who is the DPOA for a person's finances. The person holding DPOAHC is often referred to as a health care proxy, health care agent, or surrogate decision maker. A DPOAHC allows the surrogate decision maker to make a decision only if the patient has become cognitively impaired, according to the judgment of the primary health care provider. DPOA requires the decision maker to receive information, evaluate, deliberate, and communicate a treatment preference.

Which of a new nurse's statements regarding the American Nurses Association (ANA) indicates a need for further teaching? 1 "It supports the concept of active euthanasia." 2 "It has developed guidelines for safe patient handling in any health care setting." 3 "It states that nurses should act as patient advocates in their professional scope of practice." 4 "It supports the patients' rights and their stand-in decision makers to refuse or cease treatment."

1 "It supports the concept of active euthanasia." Active euthanasia is when a health care provider takes an action that decisively and directly causes a patient's death. The ANA does not support this concept. To prevent work-related musculoskeletal disorders, the ANA, along with the National Institute for Occupational Safety and Health and the Veterans Health Administration, has developed guidelines for safe patient handling in any health care setting. According to the ANA Code of Ethics, nurses should act as patient advocates within their professional scope of practice if and when patients are not capable of self-determination. Professional organizations such as the ANA and religious communities support the right of patients and their stand-in decision makers to refuse or cease treatment.

A religious community believes that God has prescribed an appointed time of death for everyone. Which statement is true about this community's beliefs regarding death? 1 "There is a new and better life after death." 2 "There is an afterlife of heaven or hell after death." 3 "The dead body should be attended to until the funeral." 4 "The dead body should be embalmed, displayed, or cremated."

1 "There is a new and better life after death." The Muslim community believes that God has prescribed an appointed time of death for everyone. According to Islam, death is seen as the beginning of a new and better life. Christians believe in an afterlife of heaven or hell once the soul has left the body. According to Judaism, a body should not be left unattended until the funeral and should not be embalmed, displayed, or cremated.

The family of an unconscious dying patient realizes that their mother will die soon. The patient's children are having a difficult time letting go. How does the nurse respond to the needs of this family? 1 "This must be difficult for you." 2 "She will soon be in a better place." 3 "Things will be fine, try not to worry so much." 4 "Don't be upset; she wouldn't want it that way."

1 "This must be difficult for you." Accept whatever the grieving person says about the situation. Remain present, be ready to listen attentively, and guide gently. In this way, the nurse can help the bereaved prepare for the necessary reminiscence and integration of the loss. The patient's or family member's pain of loss should never be minimized. Trite assurances such as saying, "Things will be fine" or "Don't be upset; she wouldn't want it that way," should be avoided. Such comments can actually be barriers to demonstrating care and concern. Never try to explain a patient's death or impending death in philosophic or religious terms; such statements are not helpful when the bereaved person has yet to express feelings of anguish or anger.

A dying patient exhibits signs of agitation. The Foley catheter has drained 100 mL in the last 3 hours, and the patient's last bowel movement was yesterday evening. What does the nurse do first? 1 Administers an analgesic 2 Assesses the patient for impaction 3 Changes the Foley catheter to ensure adequate drainage 4 Arranges for a consultation with a bereavement counselor

1 Administers an analgesic Agitation may be indicative of pain, which must be addressed in the dying patient. Arranging for a consultation with a counselor is not the priority in this situation. The dying patient's metabolism has slowed, so assessing for impaction may not be necessary. The Foley catheter should not be changed, but the tubing should be assessed to ensure that there are no kinks.

Which nursing action is appropriate for a patient who perceives a threat to his or her continued existence? 1 Assessing the belief system of the patient 2 Offering religious documents to the patient 3 Recommending the nurse's faith to the patient 4 Asking the patient to keep faith regarding the recovery

1 Assessing the belief system of the patient When the patient perceives threat about his or her continued existence, it is called spiritual distress. The nurse should first assess the patient's belief system to learn regarding the spiritual needs of the patient. The nurse then arranges appropriate support that helps the patient to deal with any spiritual distress. Spiritual needs are independent of religion; therefore offering religious documents to the patient will not necessarily help the nurse fulfill the patient's spiritual needs. The nurse should encourage the patient to share his or her fears related to the disease; the nurse should not recommend his or her own faith to the patient. Motivating the patient to keep faith is not a part of helping a patient cope with spiritual distress.

The nurse at the hospice center is caring for a terminally ill patient. What psychosocial intervention by the nurse provides support to the patient and family? 1 Encouraging reminiscence 2 Explanation of the impending loss 3 Avoiding discussion about spirituality 4 Refraining from discussing physical signs of death

1 Encouraging reminiscence The nurse should encourage reminiscence for both the patient and family to provide the ability to attain perspective and enhance meaning. The nurse should not try to explain the impending loss to the family; it may not be acceptable. The nurse should teach about the physical signs of death to the family and should promote spirituality, if the patient and family are receptive, and be culturally sensitive.

Which is legally true regarding active euthanasia? 1 It may be voluntary or involuntary. 2 It requires nurses to be involved in the procedure. 3 It is supported by most professional organizations. 4 It involves taking an action that is intended to have a good effect but also has a known harmful effect.

1 It may be voluntary or involuntary Active euthanasia may be voluntary or involuntary. Nurses should not be involved in active euthanasia or physician-assisted euthanasia. Active euthanasia is not supported by most professional organizations. In the principle of double effect, an action intended to have a good effect also has a known harmful effect; this is not true of active euthanasia.

Which condition, when assessed in a dying patient, requires that the nurse take action? 1 Moaning 2 Anorexia 3 Cool extremities 4 Alternating apnea and rapid breathing

1 Moaning Moaning indicates pain and requires pain medication. Alternating apnea and rapid breathing, anorexia, and cool extremities are normal assessment findings in the dying patient.

A dying patient cannot swallow and is accumulating audible mucus in the upper airway (death rattles). The nursing assistant reports that these noises are upsetting to family members. What does the nurse tell the assistant to do? 1 Place the patient in a side-lying position so secretions can drain. 2 Position the patient in a high-Fowler's position to minimize secretions. 3 Assist the family in leaving the room so that they can compose themselves. 4 Use a Yankauer suction tip to remove secretions from the patient's upper airway.

1 Place the patient in a side-lying position so secretions can drain Placing the patient in a side-lying position to facilitate draining of secretions (by gravity) is the appropriate nursing care intervention. As secretions diminish, noisy respirations will decrease. Asking the family to leave at this important time is not appropriate. Placing the patient in a high-Fowler's position is ineffective in helping the patient who has lost the ability to swallow; the danger of choking and aspiration would increase. Not only is oropharyngeal suctioning outside the scope of practice of the nursing assistant, it is also not recommended for removal of secretions because it is not effective and may even agitate the dying patient.

The nurse at the hospice center is caring for a patient approaching death. The patient is unable to cough up secretions effectively. What interventions does the nurse perform for this patient? 1 Position the patient on the side. 2 Massage the patient's forehead. 3 Offer ice chips at frequent intervals. 4 Use moist swabs to keep the lips and mouth moist.

1 Position the patient on the side If the patient is unable to cough up secretions, the nurse should position the patient on the side. The patient is offered ice chips to prevent dryness of the mouth and lips. The patient's forehead is massaged to soothe the restless patient with decreased metabolism and slowed circulation to the brain. Moist swabs are used to keep the lips and mouth moist in patients with reduced metabolic needs.

Which term reflects the concept that listening and acknowledging the legitimacy of a patient's and/or family's impending loss is often more therapeutic than speaking? 1 Presence 2 Spirituality 3 Life review 4 Reminiscence

1 Presence Presence refers to listening and acknowledging the legitimacy of a patient's and/or family's impeding loss. Spirituality is whatever or whoever gives ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Life review is a structured process of reflecting on one's life, which is often facilitated by an interviewer. Reminiscence is the process of randomly reflecting on memories of events in one's life.

A hospice patient has just died. Which of these postmortem nursing tasks is most appropriate to delegate to a nursing assistant? 1 Removing or cutting all IV lines or tubes according to the hospice policy 2 Assessing the patient for cessation of respiratory effort and lack of pulse 3 Notifying the spouse and other family members about the patient's death 4 Documenting the time of death and required assessment data on the chart

1 Removing or cutting all IV lines or tubes according to the hospice policy Preparing the body for viewing by the family (such as removing tubing and lines) and/or transfer to the morgue is an appropriate task for unlicensed assistive personnel (UAP). Assessing for signs of life, documenting about the death, and spousal and family notification all require broader education and should be done by licensed nursing staff.

Which statement precisely differentiates spirituality and religion? 1 Spirituality is the purpose in one's life; religion is a formal belief system. 2 Spirituality deals with rituals and other practices; religion may or may not include the belief in God. 3 Spirituality helps patients cope with death; religion helps patient to cope with the suffering related to any disease. 4 Spirituality provides a framework for making sense of life; religion invites particular ways of being in the world in relation to others.

1 Spirituality is the purpose in one's life; religion is a formal belief system. Spirituality is whatever or whoever offers ultimate purpose or meaning in one's life and may or may not include belief in God; religion is a more formal system associated with beliefs, rituals, texts, and other practices that are shared by a whole community. Both spirituality and religion can help an individual to cope with death and disease. A patient may associate violation of religious values and spirituality as the cause for any long-term pain. Spirituality provides ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Religion provides a framework that makes the sense of life. Spirituality may or may not include the belief in God. People perform religious rituals and practices.

A registered nurse is explaining concepts about euthanasia to a nursing student. Which example will the nurse use to illustrate passive euthanasia? 1 Taking a patient in a vegetative state off mechanical ventilation 2 Giving the patient a drug the patient can swallow to stop the heartbeat 3 Injecting the patient with a medication that will allow the patient to die painlessly 4 Giving the patient a drug the patient can inject that will allow the patient to die painlessly

1 Taking the patient in a vegetative state off mechanical ventilation Passive euthanasia is the withdrawal or withholding of life-sustaining therapy that cannot cure the patient; taking a patient in a vegetative state off mechanical ventilation is an example of this. Giving the patient a drug that he or she can swallow to stop the heartbeat is an example of physician-assisted suicide. Injecting the patient with a medication that will allow the patient to die painlessly is an example of voluntary active euthanasia. Giving the patient a drug that he or she can inject to cause a painless death is an example of physician-assisted suicide.

A hospice patient becomes too weak to swallow. What does the nurse do initially to increase the patient's comfort? 1 Teaches the family how to provide oral care 2 Obtains a physician order to initiate an IV line 3 Explains to the family that aspiration may be a concern 4 Administers nutrition and fluids through a nasogastric tube

1 Teaches the family how to provide oral care Because the oral mucosa will become dry, family members should be taught how to moisten the lips and mouth. Although fluids can be given through a nasogastric tube and fluids can be given through an IV line, these are generally considered to increase discomfort by prolonging the patient's suffering. Aspiration is not a concern in terminally ill patients because fluids are not given orally to patients with decreased swallowing.

A primary health care provider is accused of performing involuntary active euthanasia on a patient. Which scenario is an example of this? 1 The health care provider provided medication to cause death without the patient's consent. 2 The health care provider gave the patient medication to allow the patient to commit suicide. 3 The health care provider stopped administering chemotherapy to a patient with terminal cancer. 4 The health care provider put the patient on a drug that improved the patient's condition but had severe adverse effects.

1 The health care provider provided medication to use death without the patient's consent In involuntary active euthanasia, the health care provider uses medication to end the patient's life without the patient's consent. Providing a medication to the patient that can be used to commit suicide is physician-assisted suicide. An action that has both good and harmful effects, like beneficial medication with severe side effects, is the principle of double effect. Withholding a medication to prolong a patient's life is withdrawal or withholding of life-sustaining therapy.

A patient with a terminal illness wishes to appoint a friend as the health care proxy through the durable power of attorney for health care (DPOAHC). The nurse provides education about DPOAHC. Which action by the patient indicates understanding of the teaching? 1 The patient keeps the legal document in a deposit box. 2 The patient provides a copy of the legal document to family members. 3 The patient requests the health care provider to complete the DPOAHC. 4 The patient plans to transfer personal property to the friend's name, following death.

1 The patient keeps the legal document in a deposit box A patient can appoint a person through the durable power of attorney for health care (DPOAHC) to make health care decisions on the patient's behalf, if he or she becomes unable to do so because of advanced illness. This legal document should be kept secure, preferably in a safe deposit box or fireproof box. A DPOAHC can be completed by anyone, not necessarily a health care provider. The patient's friend and the health care provider should have a copy of the DPOAHC; a family member is given a copy of the legal document if they are included in the advanced directive. The patient's friend has a DPOAHC, which allows the patient's friend to make health care decisions on the patient's behalf. It does not facilitate inheritance of the patient's property.

The nurse is caring for a Jewish patient in the hospice center. What is this patient's likely attitude and belief regarding terminal illness? 1 The patient should not be left alone. 2 Foregoing treatment is morally permissible. 3 Lie facing Mecca during the last days of life. 4 The sacrament of the sick must be administered by a priest.

1 The patient should not be left alone As per Jewish law, a person who is extremely ill and dying should not be left alone. A Christian patient may forego treatment if it is morally permissible, and may also receive the sacrament of the sick administered by a priest. A patient of Islamic faith may want to lie facing Mecca during the last days of life.

Which should the nurse include when assessing the spiritual needs of a patient during end-of-life care? 1 The patient's cultural practices 2 The caregiver's feelings about death 3 The nurse's belief about end-of-life care 4 The health care provider's prescribed medications

1 The patient's cultural practices The nurse should include the patient's cultural beliefs and practices when assessing spiritual needs during end-of-life. The nurse's own beliefs, the caregiver's feelings about death, and the health care provider's prescribed medications are not included in the assessment of the patient's spiritual needs at the end-of-life.

The nurse is caring for a patient who exhibits Cheyne-Stokes respiration. Which other symptom does the nurse anticipate finding in the patient? 1 Urinary incontinence 2 Increase in metabolism 3 Regular sleeping patterns 4 Uniform body temperature

1 Urinary incontinence Cheyne-Stokes respiration is an indication that the patient is likely to soon die. The patient is also likely to have urinary incontinence because of the relaxation of the perineal muscles. When a patient is approaching death, there will be a decrease in metabolism and the patient will eat and drink less. The patient will also sleep longer as a result of decreased metabolism. Body temperature will decrease, especially in the extremities, and the patient's body will be cool.

Which interventions should be performed for a terminally ill patient to control the symptoms of severe distress? Select all that apply. 1 Discontinue opioids if the patient has oliguria. 2 Give soft foods and liquids if the patient has dysphagia. 3 Discontinue benzodiazepines if the patient develops delirium. 4 Perform oropharyngeal suctioning if the patient has wet secretions. 5 Stop oxygen therapy if the patient is dyspneic and the oxygen saturation is 90%.

1,2,3 Opioids should be discontinued when the patient is oliguric because the kidneys cannot excrete opioid metabolites from the body. This may lead to delirium in the patient. Soft foods and liquids should be given if the patient has dysphagia as liquids may be easily swallowed. Delirium is the adverse effect of benzodiazepines. So, benzodiazepines should be discontinued if the patient develops delirium. Oropharyngeal suctioning should not be performed as it causes agitation in the patient who has wet secretions. Oxygen therapy should not be discontinued even when the oxygen saturation is 90%, as the patient is experiencing dyspnea.

In which newly admitted patient situations does the nurse initiate a conversation about advance directives? Select all that apply. 1 The patient with end-stage kidney disease 2 A patient with a non-life-threatening illness 3 The laboring mother expecting her first child 4 A person who currently has advance directives 5 The comatose patient who was injured in an automobile crash

1,2,3,4 All patients who are hospitalized need to be asked about advance directives by the nurse when they are admitted to a hospital. This is a requirement of the Patient Self-Determination Act. Many nurses feel uncomfortable discussing advance directives with "healthy" patients, but the circumstances of admission do not relieve the nurse of this responsibility. The patient with pre-existing advance directives still needs to be questioned; it is possible that the patient's wishes have changed since the documents were established. Patients who have potentially life-threatening diseases or conditions should establish advance directives while they are able to do so. The comatose patient is not considered capable of making decisions about his or her wishes concerning advance directives.

Which questions should the nurse include regarding a Cherokee Indian patient's medicine wheel dimensions when conducting a spiritual assessment? Select all that apply. 1 "Are there any specific colors you would like to include?" 2 "Are there any specific rituals you would like to include?" 3 "Are there any specific seasons you would like to include?" 4 "Are there any specific directions you would like to include?" 5 "Are there any specific alternative therapies you would like to include?"

1,2,3,4 A medicine wheel represents the spiritual journey to find one's own path for indigenous people, including American Indians. The medicine wheel helps people in these groups maintain balance and harmony within four life dimensions. Depending on specific tribal practices and beliefs, the dimensions may be represented by colors, seasons, or directions, and the wheel can be used in different types of rituals. Questions related to alternative therapies may be a part of the spiritual assessment, but not necessarily in relation to this medicine wheel.

A patient with colon cancer being admitted to hospice care does not have an advance directive. Which elements does the nurse include in the discussion with the patient and family about advance directives? Select all that apply. 1 Portable do-not-resuscitate (DNR) order 2 Instruction about life-sustaining treatment 3 Instructional directive for health care professionals 4 Durable power of attorney for health care (DPOAHC) 5 Reminder that an advance directive cannot be changed once it is filed

1,2,3,4, At the time of admission to hospice care, the nurse should document the presence of an advance directive by the patient. An advance directive is a legal document or directive about the patient's decisions regarding life-sustaining treatment when he or she loses decision-making capacity. Living wills and medical directives such as DNR orders are instructional directives that help health care professionals make the appropriate decision(s) as per the patient's will. A portable DNR order or a DNR order written in advance is an advance directive. A patient can appoint a health care proxy by providing a DPOAHC regarding their health care to make decisions for the patient in the event of loss of decision-making capacity. An advance directive can be altered once it is filed, but will need to be witnessed again.

Which circumstance contraindicates the use of haloperidol in a dying patient? 1 Delirium 2 Risk for death 3 Use of another antipsychotic drug 4 Risk for an adverse cardiovascular event

3 Use of another antipsychotic drug A patient should not be given more than one antipsychotic drug at a time because of the risk for adverse drug events; so administering haloperiodol with another antipsychotic drug is contraindicated. Haloperidol is used to treat delirium and will not cause it. Although the risk for death or a cardiovascular event is present, these are low enough that the drug's benefits outweigh the risks.

Which questions are appropriate for the nurse to include when caring for a terminally ill Jewish patient? Select all that apply. 1 "Would you like to recite the Shema?" 2 "Should we contact someone from your mosque?" 3 "Would you like for your remains to be cremated?" 4 "Would you like someone to stay with you right now?" 5 "Would you like to receive the Sacrament of the Sick?"

1,4 Jewish patients are required to recite the Shema. They are also not to be left alone, so if a family member isn't present, the nurse may offer to stay or have someone stay with the patient. The Sacrament of the Sick is part of the Catholic, not Jewish, faith. Contacting a mosque is appropriate for a patient of Muslim, not Jewish, beliefs. Jewish people do not believe in cremation, so this would be an inappropriate question to ask.

A patient with a terminal illness is near the end of life. The patient refuses to eat or drink anything. To respect the patient's wishes, the nurse should intervene when the patient's caregiver performs which actions? Select all that apply. 1 Requests an order to give intravenous fluids 2 Allows the patient to refuse eating or drinking 3 Offers small sips of water at frequent intervals 4 Applies moistened swab sticks to his or her lips 5 Coaxes the patient to have fluids, such as juices

1,5 When near the end of life, the patient should be allowed to die peacefully without performing unnecessary interventions. The nurse should respect the patient's last wishes and should not push the patient into eating or drinking. Intravenous fluids administration is not needed near the end of life because it could be stressful, painful, and uncomfortable for the patient. If the patient chooses to not eat or drink, the patient should not be forced to do so. Forcing the patient can cause stress and discomfort in the patient. Offering small sips of water at frequent intervals helps keep the patient's oral cavity hydrated. Applying moist swab sticks to the lips also helps prevent dryness of the mouth.

The nurse manager for home health and hospice is scheduling daily patient visits. Which patient is appropriate for the nursing assistant to visit? 1 Advanced cirrhosis of the liver; called the hospice agency reporting nausea 2 Aggressive brain tumor; needs daily assistance with ambulation and bathing 3 Prostate cancer and bone metastases; has new-onset leg weakness and tingling 4 Inoperable lung cancer; considering whether to have radiation and chemotherapy

2 Aggressive brain tumor; needs daily assistance with ambulation and bathing Assisting patients with activities of daily living (ADLs) is a common role for nursing assistants working in home health or hospice agencies. Assessing and acting upon a new symptom (nausea), helping patients make decisions, and evaluating a new-onset symptom all require more complex assessment skills and interventions, which are within the RN scope of practice.

While caring for a terminally ill patient, the nurse finds that the patient has dysphagia, dehydration, and dry lips. Which action would the nurse take? 1 Give a liquid diet to the patient. 2 Apply emollient to the patient's lips. 3 Offer mashed potatoes to the patient. 4 Infuse intravenous (IV) fluids for the patient.

2 Apply emollient to the patient's lips Emollients should be applied to the patient's lips to promote comfort and prevent dryness of the lips. As the patient has dysphagia, the nurse should not give mashed food to the patient. A liquid diet also should be stopped, as the patient is unable to swallow. IV fluids should not be given to a terminally ill patient, as this may increase respiratory secretions, as well as increasing gastric secretions, nausea, vomiting, edema, and ascites.

A dying patient is having difficulty swallowing oral medications. Which intervention does the nurse implement for this patient? 1 Does not give the medications and documents: "Unable to swallow" 2 Asks the provider if the medications can be discontinued or substituted 3 Asks the pharmacy to substitute intramuscular (IM) equivalents for the medications 4 Crushes the pills, opens the sustained-release capsules, and mixes them with a spoonful of applesauce

2 Asks the provider if the medications can be discontinued or substituted Since the patient is in the dying process, he or she may no longer require some of the medications prescribed, and other routes may be available for medications that will promote comfort. The IM route is almost never used for patients at the end of life because this method is invasive and painful and can cause infection. Although some pills may be crushed, sustained-release capsules should not be taken apart and their contents administered directly. The patient may still need the medications prescribed for comfort; withholding them could cause discomfort throughout the dying process.

Why does the hospice care nurse care for the spiritual health of a patient who is in the advance stage of cancer? 1 It helps to provide explanations of the loss. 2 It helps to improve quality of life for the patient. 3 It helps to arrange for religious rituals at the time of death. 4 It helps to teach the family about the physical signs of death.

2 It helps to improve the quality of life for the patient Some patients may attach a religious or spiritual significance to their suffering and pain. By understanding the patient's spiritual beliefs, the nurse is able to provide a holistic approach to patient care, which can ultimately improve the patient's quality of life. When caring for a dying patient and the patient's family, the nurse should avoid providing explanations of loss. The nurse should teach the family about the physical signs of death; however, an understanding of the spiritual beliefs of the patient may not be helpful in doing so. The nurse may need to arrange for some of the religious rituals at the time of death; however, the spiritual beliefs of a person may be unrelated to religious beliefs and rituals.

The nurse is providing hospice care for a terminally ill patient who has stopped oral intake for about 12 hours. The family requests the nurse to administer intravenous (IV) fluids. What does the nurse tell the patient's family about the patient's intake? 1 IV fluids will be administered the next day. 2 Providing fluid or food can cause discomfort. 3 Anorexia is not common in patients at this stage. 4 It is a temporary phase, and the patient may restart oral intake.

2 Providing fluid or food can cause discomfort Giving fluid or food to the patient in hospice can cause discomfort; the patient may be at risk for aspiration. The nurse should reassure the family that anorexia is normal at this stage. Once the patient is unable to swallow, oral intake should stop; it is not a temporary phase, and the patient may not restart oral intake. The nurse should sensitively explain to the family that giving fluids can lead to increased secretions and cause discomfort in the patient with multi-system slowdown.

A patient dying of cancer is receiving high doses of opioids. In addition, which intervention is the most effective for this patient? 1 Classical music 2 Short, light massage 3 More pain medication 4 Deep muscle massage

2 Short, light massage Massage has been shown to decrease pain in individuals with cancer. Light pressure is best, and deep or intense pressure should be avoided. Although music therapy may be effective, the type of music played should be the patient's choice; it should not be assumed that the patient wants to hear classical music. The dying patient who is frail may not tolerate an extensive deep massage. The patient is already receiving high doses of opioids; complementary or alternative therapy can replace the need for increased pain medication.

Which should the nurse consider when preparing to meet a patient's spiritual needs during hospitalization? 1 Spiritual needs cannot be met without religion. 2 Spiritual needs are whatever gives purpose to a patient's life. 3 Spiritual needs should focus on the patient's relationship with God. 4 Spiritual needs should focus only on the patient's designated religion.

2 Spiritual needs are whatever gives purpose to a patient's life. Spirituality comprises whatever or whoever l gives meaning and purpose to one's life, including ways of being in the world in relation to others, oneself, and the universe. A patient's spiritual needs may be met with or without religion, depending on preference. A patient might have spiritual needs but no designated religion. A patient might have spiritual needs without belief in God.

What term refers to ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe? 1 Religion 2 Spirituality 3 Life review 4 Reminiscence

2 Spirituality Spirituality refers to whatever or whoever gives ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Religion is a formal belief system that provides a framework for making sense of life, death, and suffering. Life review is the structured process of reflecting on one's life. Reminiscence is the process of randomly reflecting on memories of the events in one's life.

A patient is diagnosed with a degenerative illness and will die in less than a year because of the progressive nature of the disease and its complications. To deliver the appropriate level of care, the nurse identifies that which goal is the most important for the patient? 1 To provide end-of-life care 2 To improve the quality of life 3 To rehabilitate and help lead a normal life 4 To provide intensive treatment for the illness

2 To improve the quality of life The patient has a life expectancy of less than a year and is expected to die from complications of the disease. Therefore the patient should receive palliative care to relieve suffering from symptoms and promote quality of life. The patient would have been an appropriate fit for hospice care to receive end-of-life care if the life expectancy was less than 6 months. Intensive care is provided if the condition is reversible and the treatment could be life-saving. Rehabilitative care is appropriate for patients with a physical disability, but not a terminal illness.

The registered nurse is teaching a nursing student about anti-psychotic drug haloperidol. Which nursing student statement indicates effective learning? 1 "It is eliminated from the system slowly." 2 "It is administered to a patient before surgery." 3 "It increases the chance of hyperglycemia and diabetes mellitus." 4 "It is commonly used in a low dose to treat terminal delirium in dying patients."

4 "It is commonly used in a low dose to treat terminal delirium in dying patients" Haloperidol, a type of anti-psychotic, may be used in low doses to treat delirium in dying patients. Antianxiety, not anti-psychotic, drugs may be administered before surgery. Antianxiety, not anti-psychotic, drugs are eliminated slowly. Hyperglycemia and diabetes mellitus are more concerning for patients who are given risperidone.

The nurse is caring for a patient near death who has loud, wet respirations. Which interventions would be most appropriate for the patient to relieve dyspnea? Select all that apply. 1 Monitor vitals to assess for infections. 2 Administer atropine solution 1% sublingually. 3 Place a small towel under the patient's mouth. 4 Re-position the patient to one side on the hospital bed. 5 Perform oropharyngeal suctioning to clear the secretions.

2,3,4 Atropine solution should be administered sublingually every 4 hours to a patient with loud, wet respirations. Atropine helps to dry up secretions. A small towel should be placed under the patient's mouth to collect secretions. The patient should be re-positioned to one side on the bed to reduce gurgling. Assessing for infections in a patient near death would not be a priority action. Oropharyngeal suctioning should not be performed in a patient with loud, wet respirations as it is often not effective and it may result in agitation.

The nurse is teaching the caregiver of a patient who is in the late stages of terminal cancer and has stopped eating and drinking. Which actions performed by the caregiver indicate effective care? Select all that apply. 1 Forcing the patient to eat 2 Applying lip balm to the patient's lips 3 Providing ice chips at frequent intervals 4 Using moist swabs on the patient's mouth and lips 5 Positioning the patient on his or her side to cough up secretions 6 Speaking as loudly as possible to the patient so he or she can hear

2,3,4 Fluid and food intake decreases in a patient approaching death due to decreased metabolic needs. The caregiver should use moist swabs on the patient's mouth and lips to keep them moist and comfortable, and the caregiver can apply lip balm to the patient's lips. To manage fluid levels, the caregiver can give the patient small sips of liquids or ice chips at regular intervals if he or she can swallow. The caregiver should not force the patient to eat or drink during this stage. Positioning the patient on his or her side may help the patient cough up secretions, but it does not address the patient's lack of desire to eat or drink. Speaking loudly to the patient is unnecessary; rather, the caregiver should speak softly and clearly.

The east, or yellow, domain of a patient's medicine wheel focuses on the spiritual aspects of care. Which additional components should the nurse assess? Select all that apply. 1 Trust 2 Energy 3 Emotion 4 Illumination 5 Enlightenment

2,4,5 When assessing the east, or yellow, domain of a patient's medicine wheel, the nurse will focus on energy, illumination, and enlightenment along with spirituality. Trust and emotion are assessed when focusing on the south, or red, domain of the medicine wheel.

Arrange in order the pathophysiological events that take place during the dying process. 1. Cardiac arrest 2. Multiple organ failure 3. Occurrence of anaerobic metabolism 4. Inadequate blood supply to body tissues 5. Release of toxic metabolites in vital organs

4,3,5,2,1 Inadequate blood supply to body tissues leads to unmet oxygen demand. It stimulates anaerobic metabolism leading to acidosis, hyperkalemia, and tissue ischemia. This results in release of toxic metabolites in the vital organs such as the kidneys and the liver, which may result in organ failure causing cardiac arrest.

A registered nurse is teaching a nursing student about hospice care. Which statements made by the nursing student regarding hospice care are true? Select all that apply. 1 "It is not limited to a specific time period." 2 "It is provided to the patient in any stage of a serious illness." 3 "It can be provided to a cancer patient when curative treatment is discontinued." 4 "It includes registered nurses, social workers, chaplains, and volunteers who participate in the caring process." 5 "It is provided when patients have a prognosis of six months or less to live."

3,4,5 Hospice care can be provided to a patient when curative treatment, such as chemotherapy, is stopped. Registered nurses, social workers, chaplains, and volunteers all participate in providing hospice care. Hospice care is provided to patients who have a prognosis of six months or less to live. Palliative care, not hospice care, is not limited to any specific time periods. Palliative care, not hospice care, is provided to a patient in any stage of serious illness.

The registered nurse is discussing stress relief in hospitalized patients who have terminal cancer with a licensed practical nurse (LPN). Which of the LPN's statements indicates a need for further discussion? 1 "I should re-orient the patient." 2 "I should coat the patient's lips with lip balm." 3 "I should discourage family members from visiting." 4 "I should elevate the patient's head for easier breathing."

3 "I should discourage family members from visiting" A patient who is in the terminal stage of cancer and approaching death should be allowed to have family members and/or friends present in his or her room for support and comfort if he or she wishes. The LPN should re-orient the patient as needed. The LPN should coat the lips of the patient with lip balm to help keep the lips moist. The LPN should elevate the patient's head to ensure proper breathing.

The nurse is teaching the family members about end-of-life care for a terminally ill patient. Which caregiver statement indicates a need for further teaching? 1 "I can sit quietly beside the patient." 2 "I should spend as much time as possible with the patient." 3 "I should wake up the patient if he or she sleeps continuously." 4 "I should talk to the patient normally even if there is no response."

3 "I should wake up the patient is he or she sleeps continuously." A family caring for a terminally ill patient should let him or her sleep without waking him or her up. The other statements indicate understanding. They should spend as much time as possible with the patient by sitting quietly beside them. They should talk to the patient normally even when there is no response.

The nurse is assisting a patient's family members who are grieving and mourning. Which statement made by the nurse indicates effective communication with the family members? 1 "Things will be fine, don't cry." 2 "In a year, you will have forgotten." 3 "This must be very difficult for you." 4 "Don't be upset. She wouldn't want it that way."

3 "This must be very difficult for you." The statement, "This must be very difficult for you," is appropriate for communicating with the patient's family during grieving process. This is an example of therapeutic communication. The other three statements, "Things will be fine," "In a year, you will have forgotten," and "Don't be upset, she wouldn't want it that way" give false assurance to the family members and should be avoided.

Which nursing question helps the hospice care nurse to know how the patient wants to connect to the outside world? 1 "Do you have any last wishes?" 2 "Are you a religious or spiritual person?" 3 "What gives you meaning or purpose in life?" 4 "Do you have any grudges with your family members?"

3 "What gives you meaning or purpose in life?" When the nurse asks the patient "What gives you meaning or purpose in life?" the question elicits the spirituality of the person and how the patient wants to connect to the outside world. "Do you have any last wishes?" and "Are you a religious or spiritual person?" are closed-ended questions that are less helpful in eliciting information. "Do you have any grudges with your family members?" is nontherapeutic and should not be approached unless the patient volunteers this information.

A patient who is scheduled for a head surgery informs the nurse that he or she does not want his or her head shaved until Easter is over and wants the date of the surgery postponed. Which entity supports the right of patients and their surrogate decision makers to refuse or discontinue treatment? 1 American Liver Foundation 2 American Dietetic Association 3 American Nurses Association (ANA) 4 American College of Cardiology (ACC)

3 American Nurses Association (ANA) The American Nurses Association (ANA) supports the right of patients and their surrogate decision makers to refuse or discontinue treatment. Supporting the right of patients and their surrogate decision makers to refuse or discontinue treatment is not a primary concern of the American Dietetic Association, American Liver Foundation, or the American College of Cardiology (ACC).

Which condition or disorder puts a patient at risk for seizure activity near death? 1 Lung cancer 2 Heart failure 3 Brain tumor 4 Neck cancer

3 Brain Tumor The patient with a brain tumor is likely to have seizure activity when close to death. Patients with lung cancer and heart failure are at high risk for respiratory distress and dyspnea. The patient with neck cancer is at risk for hemorrhage as tumors are near the major arteries.

A terminally ill patient suddenly develops symptoms of cardiac arrest. What is the priority nursing intervention? 1 Providing a blood transfusion 2 Initiating cardiopulmonary resuscitation (CPR) 3 Checking for a do-not-resuscitate (DNR) order 4 Maintaining vascular access using a large-bore catheter

3 Checking for a DNR The patient has a right to give a do-not-resuscitate (DNR) order in advance. Therefore the nurse should check for the DNR order before resuscitating the patient. A blood transfusion is performed if the patient has a hemorrhage or shock. The nurse should initiate cardiopulmonary resuscitation (CPR) if the patient has not given a DNR order. The nurse should maintain vascular access using a large-bore catheter because it helps maintain circulatory volume; however, the nurse should install a large-bore catheter only after checking for the DNR order.

The nurse recognizes signs and symptoms of depression in an 80-year-old patient who is dying from metastatic breast cancer. What does the nurse do initially for this patient? 1 Documents these findings and continues to monitor the patient 2 Assesses these behaviors as normal steps or stages in the grief process for the patient 3 Collaborates with the end-of-life (EOL) care team to manage these feelings in the patient 4 Reduces the quantity of depression-causing opioids that are being administered to the patient

3 Collaborates with the end-of-life (EOL) care team to manage these feelings in the patient Behaviors should be assessed and treated with the collaboration of the EOL care team. The nurse may be instrumental in performing a "depression" screening. Feelings of depression —hopelessness, helplessness, unhappiness—are not part of the aging process or the process of dying; they should be aggressively treated. These feelings should not only be documented and monitored, but also should be acknowledged as not a normal part of the dying process and should be treated with psychotherapy or medications or both. Inadequate analgesic pain control is one of the most noted and critical problems, especially in older adults. This scenario would not be a reason for opioid administration to be reduced; such an action is harmful to the patient.

On which domain of a patient's medicine wheel should the nurse focus when planning spiritual care? 1 Center 2 West/black 3 East/yellow 4 North/white

3 East/yellow The east or yellow portion is the spiritual domain of the medicine wheel. The center portion is associated with self-balance. The west or black portion is associated with physicality. The north or white portion is associated with mentality.

The nurse arranges for bereavement counselors to meet a terminally ill patient and family. What does the bereavement counselor do? 1 Assesses the spiritual needs of the dying patient 2 Explains the loss in philosophic or religious terms 3 Helps the patient and family to cope prior to and after death 4 Fosters hope for the patient and family by listening and caring

3 Helps the patient and family to cope prior to and after death The bereavement counselor helps the patient and family to cope with the situation before and after death. They are aware of the grieving process and encourage the family to be part of a support group. They do not explain loss in philosophic or religious terms. Hope gives the family the strength to go forward in darkest times. The nurse fosters hope for the patient and family by listening and caring while explaining the gravity of the situation. The nurse also assesses and identifies the spiritual needs of the dying patient. This facilitates an open expression of the patient's beliefs and needs.

Which statement is true regarding hospice care? 1 Care is provided for a period of one year. 2 Patients can be in any stage of serious illness. 3 Hospice care aims to meet the spiritual and physical needs of patients. 4 A consultation is provided to the patient that outlines curative therapies.

3 Hospice care aims to meet the spiritual and physical needs of patients In hospice care, efforts are made to meet the spiritual and physical needs of the patient in order to help the patient to cope with loss. Care is provided in 60- to 90-day periods with an opportunity to continue if eligibility criteria are met. Hospice care is provided to patients who have a prognosis of six months or less to live. Hospice care is provided when curative treatment, such as chemotherapy, has been stopped.

The hospice care nurse wants to understand the formal belief systems that provide a framework for a terminally ill patient to make sense of life, death, and suffering. What may be the reason for this? 1 It minimizes the patient's sense of loss. 2 It facilitates memories of the patient's life. 3 It best meets the patient's spiritual needs. 4 It determines whether to avoid resuscitation of the patient.

3 It best meets the patient's spiritual needs. Religions are the formal belief systems that provide a framework for making sense of life, death, and suffering. Understanding a patient's religion is important so that the nurse can understand the formal expression of the patient's spirituality and be able to help meet his or her spiritual needs. The nurse should avoid minimizing the patient or the family's sense of loss. Randomly reflecting on memories of one's life can be an important activity for the dying patient, but it is not necessarily directly related to the religious affiliation of the patient. The religious affiliation should not determine whether or not a patient should be resuscitated. Resuscitation should be started for a person who is not breathing or is pulseless unless that person has a do-not-resuscitate (DNR) order.

A family member of a patient at the hospice center tells the nurse that the patient has been seeing and talking to people not visible to others. What does the nurse tell the family member? 1 The patient is hallucinating. 2 The patient is experiencing a drug reaction. 3 The patient is having vision-like experiences. 4 The patient is preparing to "let go" from relationships.

3 The patient is having vision-like experiences The patient who is nearing death often has vision-like experiences. The patient is not hallucinating, having a drug reaction, or preparing to "let go" from relationships.

The nurse is caring for a patient who sustained a severe head injury, is in a coma, and is mechanically ventilated. There is no chance of the patient recovering because of the severe brain trauma and multiple organ failure, and the patient may die if taken off the ventilator. Which action by the health care team is classified as passive euthanasia? 1 The patient's treatment is stopped without consent from the family members. 2 The patient is injected with high doses of medications to block cardiac activity. 3 The ventilator support is withdrawn from the patient with consent from the next of kin. 4 The patient's family is provided with medications that could cause the patient's death if given.

3 The ventilator support is withdrawn from the patient with consent from the next of kin Passive euthanasia, also called withdrawing or withholding life-sustaining therapy, involves an act of omission of treatment that might prolong the life of a person who is terminally ill. Withdrawing ventilator support may not directly cause death but may lead to respiratory failure, resulting in death. Injecting the patient with high doses of medications to block cardiac activity is an example of active voluntary euthanasia. The patient's treatment being stopped without the consent from the patient's family is involuntary active euthanasia. Providing the patient's family with medications that lead to the patient's death if administered is an example of physician-assisted suicide.

A patient admitted with a non-life-threatening illness says, "I was asked to fill out an advance directive when I was admitted, but I was too stressed. What was it all about?" How does the nurse respond? 1 "Advance directives are only for those individuals who are severely ill." 2 "You should have completed the paperwork before you were admitted." 3 "Most Americans have an advance directive in place; you will need to see a lawyer." 4 "Advance directives allow a patient to convey his or her wishes about health care ahead of time."

4 "Advance directives allow a patient to convey his or her wishes about health care ahead of time" Stating that advanced directives allow a patient to convey his or her wishes about health care ahead of time is true and best addresses the patient's comments. Advance directives should be in place before the patient becomes severely ill. Most Americans do not have advance directives in place. Legal assistance is not necessary to complete them. Although completing paperwork pertaining to advance directives before admission would be ideal, any time is a good time to do this.

The registered nurse is observing a student nurse providing a massage to a patient with spinal cancer undergoing radiation therapy. Which recommendation would the registered nurse give to the student nurse? 1 "Massage by applying deep, intense pressure." 2 "Massage only where the patient wants you to." 3 "Massage over the damaged tissue to ease pain." 4 "Massage tissues not undergoing radiation therapy."

4 "Massage tissues not undergoing radiation therapy." The registered nurse would advise the student nurse not to massage over the tissue undergoing radiation therapy to avoid additional pain and discomfort for the patient. The registered nurse would advise the student nurse to use light pressure, especially for cancer patients. The nurse would encourage the patient to have as extensive a massage as is possible to aid in relaxation and pain management. The registered nurse should advise the student nurse not to massage over the damaged tissue to avoid further pain and discomfort.

A patient in the terminal stage of breast cancer is admitted to hospice. The family caregiver tells the nurse to reduce the dosage of pain medication as it is making the patient sleepy. What is the most appropriate answer by the nurse to the caregiver? 1 "If sleepiness does not lessen after 3 days, the pain medication dose will be adjusted." 2 "As long as the patient's pain is controlled, the level of sedation will have to be maintained." 3 "Sleepiness is an indication of the progression of the disease and the patient is 'letting go.'" 4 "The patient had not slept well because of pain; the patient is resting well now because pain is reduced."

4 "The patient had not slept well because of pain; the patient is resting well now because the pain is reduced" The patient may be exhausted from not sleeping well while in pain; the medication helps to reduce pain, and the patient is now able to sleep. The nurse needs to educate the family about pain medication and their side effects. The medication is used to reduce pain and not sedate the patient. Pain medication dosages are adjusted depending on the pain level. Sleepiness in this patient may not be an indication of progression of the disease or the patient "letting go."

Family members of a dying patient are disturbed as they watch their loved one alternating between periods of apnea and periods of rapid breathing. Which is the most suitable response by the nurse? 1 "The patient will die when the respirations stop." 2 "The changes in breathing are a common sign of the end of life." 3 "Pain medication will be administered when the patient reports pain." 4 "These signs generally do not cause physical discomfort to the patient."

4 "These signs generally do not cause physical discomfort to the patient" The nurse would inform the family that breathing irregularities generally do not cause physical discomfort to the patient. Telling family that the changes in breathing are a sign/symptom of physical decline and that pain, weakness, and breathlessness are common symptoms of the end of life is factual but not therapeutic. Stating that the patient will eventually die when the heartbeat and respirations stop is also factual but not therapeutic. Even if the patient does not express the presence of pain and discomfort, pain medication should be administered at regular intervals or as needed. The nurse would not expect a patient in this state to report pain.

The daughter of a dying patient says, "I don't want my father to be uncomfortable." How does the nurse respond? 1 "Your father will be kept sedated." 2 "Do you want to talk to the bereavement nurse?" 3 "We will send him to hospice when the time comes." 4 "Your father will be closely monitored and cared for."

4 "Your father will be closely monitored and cared for" Telling the daughter that her father will be closely monitored and cared for provides support and comfort. The daughter's comment does not require the expertise of a bereavement nurse. Also, asking if the daughter wants to talk to a bereavement nurse is a yes or no question and a nontherapeutic response; it shuts off the dialog. The dying patient is not typically kept sedated; patients are kept comfortable with as little or as much pain medication as needed. A goal is to keep him or her alert and able to communicate. Telling the daughter that her father will be sent to hospice when the time comes does not address the daughter's concern about her father's comfort; it closes the dialog.

A patient with terminal lung cancer asks the physician for help ending his or her life. How are voluntary active euthanasia and physician-assisted suicide similar? 1 Both may have both good and harmful effects. 2 Both involve the patient administering a death-causing agent. 3 Both involve the physician stopping life-prolonging measures. 4 Both involve the physician providing the means for the patient's death.

4 Both involve the physician providing the means for the patient's death In voluntary active euthanasia and physician-assisted suicide, the health care provider provides a means for causing the patient's death; in voluntary active euthanasia, the provider administers it, and in physician-assisted suicide, the patient does. Withholding life-sustaining therapy involves the physician stopping life-prolonging measures. The double effect principle is the concept that an action has both a good effect and a harmful effect. In voluntary active euthanasia, the physician, not the patient, administers the death-causing agent.

The health care team is getting ready to perform cardiopulmonary resuscitation (CPR) on a patient. The patient's son tells the nurse not to resuscitate the patient. What is the appropriate action for the nurse to take? 1 Tell the son to hold the patient's hand during CPR. 2 Honor the son's request and stopping the resuscitation. 3 Ask the son if the patient has a do-not-resuscitate order. 4 Check to see if the patient has a living will stating that CPR is not to be used.

4 Check to see if the patient has a living will stating that CPR is not to be used The nurse should determine if the patient has a living will that states that cardiopulmonary resuscitation (CPR) not be used. By law, the nurse must perform CPR for a person who is not breathing or is pulseless unless that person has a do-not-resuscitate (DNR) order. The nurse should not rely on another person's statement over that in a living will. Telling the son to hold the patient's hand does not answer the question of whether to perform CPR. Honoring the son's wishes could go against the patient's wishes if they are not in accordance with the living will.

A patient diagnosed with lung cancer 6 months ago is now ventilator-dependent and unresponsive. The family wants to remove the ventilator and stop antibiotics and intravenous (IV) fluids. What does the nurse do next? 1 Waits to obtain information on the patient's wishes 2 Removes the interventions, per the family's wishes 3 Tells the family that removing the interventions is illegal 4 Facilitates a meeting with the family and health care team

4 Facilitates a meeting with the family and health care team Withdrawing or withholding life-sustaining therapy involves discontinuing one or more therapies that might prolong the life of a person who cannot be cured by the therapy. To do this, a meeting is required between the family and the health care team. Withdrawing life support requires more than simply following the family's wishes. Removal of life-sustaining therapy is not illegal except in cases of active euthanasia or physician-assisted euthanasia. The patient most likely will not regain consciousness; the patient's wishes should have been determined and documented earlier in the course of his or her disease (advance directives, living will, etc.).

The nurse is coordinating interdisciplinary palliative care interventions for the dying patient. Which goal is the nurse seeking to meet? 1 Ensuring an expedited death 2 Meeting all of the patient's needs 3 Avoiding symptoms of patient distress 4 Facilitating a peaceful death for the patient

4 Facilitating a peaceful death for the patient Facilitating a peaceful death for the patient is one of the goals of palliative care. Symptoms of distress cannot be avoided but can be controlled. Expedited death is not a goal of palliative care. Identifying patient needs is a goal of palliative care, but it is not always possible to meet all of the patient's needs (e.g., to prevent death or lengthen life).

A patient with heart failure is experiencing dyspnea, diaphoresis, and hemoptysis, for which furosemide has been prescribed. Which route of medication administration would be used in this case? 1 Oral 2 Intramuscular 3 Subcutaneous 4 Intravenous

4 IV Dyspnea, diaphoresis, and hemoptysis are symptoms of pulmonary edema, which is a complication of heart failure. Pulmonary edema is an emergency condition that requires immediate management. In this case, the furosemide would be administered through the intravenous direct/push route. Furosemide can be administered through the oral, intramuscular, or subcutaneous route to reduce vascular congestion and the workload of the heart; however, these routes will not provide the immediate results that are needed in the management of pulmonary edema.

A terminally ill patient has reduced intake of food and fluids and sleeps most of the time. Why does the nurse withhold intravenous (IV) fluids from this patient? 1 IV fluids cause dry lips and mouth. 2 IV fluids stimulate endorphin release. 3 IV fluids increase the risk for aspiration. 4 IV fluids increase respiratory secretions.

4 IV fluids increase respiratory secretions IV fluids can increase respiratory secretions leading to distress in the patient. It is believed that dehydration in the last hours of life stimulates endorphin release that promotes a sense of well-being in the patient. The patient is at risk for aspiration if fluids were forced orally; weakness combined with decreased neurological function impairs the patient's ability to swallow. Dry lips and mouth are a side effect of dehydration.

A patient with terminal pancreatic cancer is near death and reports increasing shortness of breath with associated anxiety. Which hospice protocol order does the nurse implement first? 1 Prednisone elixir 10 mg orally 2 Albuterol 0.5% solution per nebulizer 3 Oxygen 2 to 6 L/min per nasal cannula 4 Morphine sulfate 5 to 10 mg sublingually as needed

4 Morphine sulfate 5-10 mg sublingually as needed Morphine sulfate is the standard treatment for the dyspneic patient who is near death. Albuterol, oxygen, and steroids may be useful but should be used as adjuncts to therapy with morphine.

The family of a dying patient is provided with a symptom relief kit for the patient who has chosen a home death. Prochlorperazine 25 mg suppository, which is included in the kit, is used for which sign/symptom? 1 Unrelieved pain 2 Unrelieved dyspnea 3 Loud, wet respirations 4 Nausea and vomiting

4 Nausea and vomiting Patients who choose home hospice are often provided with a symptom relief kit that provides commonly used drugs to treat symptoms near death. Prochlorperazine is used to help control nausea and vomiting. Unrelieved pain or unrelieved dyspnea is managed with morphine solution. Transdermal scopolamine is used to relieve loud, wet respirations.

The nurse is providing hospice care for a patient nearing death who has loud, wet respirations. What intervention does the nurse perform for this patient? 1 Administer appropriate antibiotics. 2 Perform oropharyngeal suctioning. 3 Provide hyoscyamine every 4 hours. 4 Re-position the patient onto one side.

4 Re-position the patient onto one side

What is the process of randomly reflecting on memories of events in one's life? 1 Religion 2 Spirituality 3 Life review 4 Reminiscence

4 Reminiscence Reminiscence is the process of randomly reflecting on memories of events in one's life. Religions are formal belief systems that provide frameworks for making sense of life, death, and suffering and responding to universal spiritual questions. Spirituality is whatever or whoever gives ultimate meaning and purpose in one's life that invites particular ways of being in the world in relation to others, oneself, and the universe. Life review is a structured process of reflecting on one's life, which is often facilitated by an interviewer.

A patient with terminal bone cancer passes away under hospice care. The nurse explains to a team member that the patient had a good death. Which activity related to the patient's death supports the nurse's statement? 1 The patient's family was kept away from seeing the patient die. 2 The patient did not give up cancer curative treatment until near death. 3 The patient had endured the cancer-associated pain without analgesics. 4 The patient and the family had been mentally prepared for the departure.

4 The patient and the family had been mental prepared for the departure A good death is one in which the deceased and the family members are mentally prepared for the death, and the patient's death is in agreement with the family members. This helps reduce the emotional pain associated with the loss. In an ideal situation, the patient's family should be with the patient for a good death; a bad death involves the patient being abandoned. When in hospice care, the curative treatments are stopped. A good death would include adequate pain-relieving measures to promote the patient's comfort.